Hazem Mofreh Al Tarawneh

Key facts

NPI

1801622683

Entity type

Individual (NPI type 1)

Primary specialty

Prosthodontics 1223P0700X

License

84371875 (WI)

Practice address

1801 W Wisconsin Ave
Milwaukee, WI 53233-2186

Phone

(414) 288-8208

NPI assigned

Sep 10, 2024

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes

Opted out of Medicare

Previously, effective Sep 12, 2024 through Sep 12, 2026

National Provider Directory

Medicare enrollment (NPD)

No

State licenses

Specialties & licenses

Addresses

Other names

• Dr. Hazem Mofreh Dakhilallah Altarawneh Other name

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 10, 2024.

{
    "created_epoch": "1725926400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725926400000",
    "number": "1801622683",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1957 W CREEKSIDE CROSSING CIR APT 210",
            "city": "OAK CREEK",
            "state": "WI",
            "postal_code": "531545699",
            "telephone_number": "414-241-0859"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1801 W WISCONSIN AVE",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532332186",
            "telephone_number": "414-288-8208"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AL TARAWNEH",
        "first_name": "HAZEM",
        "middle_name": "MOFREH",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-09-10",
        "last_updated": "2024-09-10",
        "certification_date": "2024-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "WI",
            "license": "84371875",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "HAZEM",
            "last_name": "ALTARAWNEH",
            "middle_name": "MOFREH DAKHILALLAH",
            "prefix": "DR.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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All providers in Milwaukee, WI · Prosthodontics in Wisconsin